الفهرس 
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Abstract
This study was planned to evaluate the validity of medial spike angle and fracture tip skin distance in treatment of supracondylar fracture humerus type IIIb according to gartland classification by assessing: preoperative complications, time of operation, mode of reduction, operative and earlypost operative complications, number of trials of closed reduction. The materials of this study included 39 cases of type IIIB supracondylar humerus fracture , 19 case designated as group 1 (medial spike angle less than 45 and fracture tip skin distance less than 6.50), 20 case designated as group 2(medial sike angle more than 45 and fracture tip skin distance more than 6.50mm) in group 1 age were 5.3 in group 2 were 5.6 , there were 9 boyes and 10 girls in group 1,in group 2 15 boyes and 5 girls ,The rigth elbow was affected in 9 cases in group 1 and 13 cases in group 2 the left elbow was affected in 10 cases in group 1 and 7 cases in group 2 All the collected data from the patient medical recordsanalysed for the two groups and the results was : The mean medial spike angle was 40.26° (SD 3.53) for group 1 and 60,20° (SD 10.68) for group 2 (p < 0.001) this difference in medial spike angle was defined to be statistically significant. The mean fracture tip skin distance for group 1 was 5.50 (SD 1.50) and for group 2 was 13.15 (SD 3.27) this difference in fracture tip skin distance was statistically significant. The mean operative time for group 1 was 41.84min (SD11.81) and for group 2 was 20.25min (SD6.17) this difference in operative time was statistically significant .There was no statistically difference between both groups regarding the preoperative complications but there was statistically significant differenc between both groups regarding the operative and early post operativecomplications.There was no statistically significant difference between both groups regarding mode of reduction.The number of trials for group 1 was 3.5 and for group 2 was 1.7 this difference in trials of closed reduction was statistically significant .According to these results this study do not advocate primary open reduction based on our findings. All junior orthopedic surgeons should be trained to identify patients with a displaced supracondylar humeral fracture with a medial spike and small fracture tip skin distance. They should recognise that closed reduction will be difficult if not impossible, and this is should be communicated to parents when taking informed consent. Assistance from senior staff is sought before the commencement of surgery and operating room staff are alerted to prepare for open reduction and the number of trials of closed reduction should be less than three trials. Based on the finding of this study; the following recommendation could be advised:
Preoperative check of medial spike angle and fracture tip skin distance is a valuable preoperative radiological parameters to be predict the difficulty in closed reduction, the possibility of complications, the possibility of changing decision to open reduction, also it is a valuable tool to explain the whole situation to the family while taking the informed consent.